Study Finds Decline in AMI and CHF Adverse Events

Jan 23, 2014

ACC News Story

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Even in today's ultra-precautionary and preventative medical landscape, patient safety has posed a serious challenge to the U.S. health care system. While numerous organizations and initiatives have been launched over the years to reduce adverse events in the nation's hospitals, the effects of these efforts have never been empirically clear, with previous examinations of trends in patient safety being limited with respect to regions, measures, sample sizes and data sources. A study published Jan. 22 in The New England Journal of Medicine, attempted to estimate trends in the rate of occurrence of adverse events for which patients were at risk, and found a reduction in acute myocardial infarction and congestive heart failure.

As hospitalization rates, 30-day mortality rates, care patterns, condition-specific procedure rates, and lengths of stay for acute myocardial infarction, congestive heart failure, pneumonia, and conditions requiring surgery have changed over the past several decades, little is still known about whether these changes and quality-improvement efforts have affected the safety of patients hospitalized with these conditions. Using data from the Medicare Patient Safety Monitoring System (MPSMS) between 2005-2011, the study, led by Yun Wang, PhD, Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, looked at the 21 events for which patients are deemed at risk during hospitalization, and divided them into four clinical categories: adverse drug events, general events, hospital-acquired infections, and post-procedural events. The authors determined three composite outcomes for the measures: the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1,000 hospitalizations.

Including 61,523 patients for acute myocardial infarction (19 percent), congestive heart failure (25 percent), pneumonia (30 percent), and conditions requiring surgery (27 percent) across 4,372 hospitals, the study found that the rate of occurrence of adverse events among patients with acute myocardial infarction declined from five percent to 3.7 percent and 3.7 percent to 2.7 percent among patients with congestive heart failure, translating to approximately 81,000 in-hospital adverse events being averted between 2010-2011 compared to 2005-2006.

Much to the disappointment of the authors, this kind of reduction was not seen in patients with pneumonia or those with conditions requiring surgery, indicating a continuing challenge and identifying important target for patient-safety initiatives.

While the study ultimately concluded that positive in-roads have certainly been made against some of the adverse events that take place in the nation's hospitals, the lack of a more across- the-board reduction shows that efforts are still needed to prevent patient harm.

"The results of this study demonstrate that when multiple stakeholders including professional societies like the ACC come together and commit to improving care, patient safety can improve dramatically," said JoAnne M. Foody, MD, FACC, co-author of the study and editor-in-chief of CardioSmart. "We see that in acute myocardial infarction and congestive heart failure in particular, where large robust national registries and quality improvement initiatives exist, far fewer patients are experiencing adverse events. These are very positive findings for the hundreds of thousand Americans hospitalized with these conditions annually."